益肾化湿颗粒联合舒洛地特对早期老年糖尿病肾病氧化应激及内皮功能的影响

Effect of Yishen Huashi Granules Combined with Sulodexide on Oxidative Stress and Endothelial Function in Early Diabetic Nephropathy of Elder Patients

目的:观察益肾化湿颗粒联合舒洛地特对早期老年糖尿病肾病(DN)氧化应激及内皮功能的影响。方法:86例早期糖尿病肾病患者随机分成两组,两组均给予常规治疗,对照组加用舒洛地特注射液肌肉注射600 LSU(酯酶单位),1次·d^(-1),连续治疗2周后,口服舒洛地特软胶囊,1粒/次,2次/d,连续治疗4个月。观察组在对照组治疗的基础上加用益肾化湿颗粒,10 g·次-1,3次/d。连续治疗4个月。观察治疗前后血糖,血肌酐(SCr),超氧化物歧化酶(SOD),丙二醛(MDA),血管性血友病因子(v WF),内皮素(ET)-1以及24 h尿白蛋白排泄率(24 h UAER)。结果:与治疗前比较,两组24 h UAER和SCr水平明显下降(P<0.05,P<0.01),尤其观察组更加明显[分别为(72.3±15.8)mg·(24 h)-1,(65.8±20.6)μmol·L^(-1)],与对照组[分别为(87.6±17.2)mg·(24 h)-1,(91.6±23.8)μmol·L^(-1)]比较差异有统计学意义(均P<0.05)。治疗后观察组MDA,v WF,ET-1[分别为(4.01±0.4)μmol·L^(-1),(159.5±26.4)%,(55.7±7.2)ng·L^(-1)]较治疗前明显下降(均P<0.05),与对照组[分别为(5.31±0.51)μmol·L^(-1),(181.3±28.2)%,(60.4±7.5)ng·L^(-1)]比较差异有统计学意义(P<0.05)。治疗后观察组SOD[(129.3±7.1)U·m L^(-1)]较治疗前明显上升(P<0.05),与对照组[(70.2±4.5)U·m L^(-1)]比较差异有统计学意义(P<0.05)。结论:益肾化湿颗粒具有较强抗氧化作用,能有效的延缓血管内皮的损伤,减少蛋白尿的排出,而且联合舒洛地特共同治疗,调节血管内皮功能的效果更加明显,延缓早期DN发展。

Objective： To observe the effect of Yishen Huashi granules combined with sulodexide on oxidative stress and endothelial function in early diabetic nephropathy of elder patients. Method： The 86 patients with early diabetic nephropathy were randomly divided into control group and observation group. Both groups were given with conventional therapy. The patients in control group were also treated with sulodexide intramuscular injection 600 LSU, once daily;after continuous treatment for 2 weeks, sulodexide soft capsules were orally taken, 1 capsule/time, 2 times daily, and continuous for 4 months. The patients in observation group were also treated with Yishen Huashi granules based on the treatment of control group,10 g/time, 3 times daily, and continuous for 4 months. Blood glucose, serum creatinine （SCr）, superoxide dismutase （SOD）, malondialdehyde （MDA）, vascular pseudo von Willebrand factor （vWF）, endothelin （ET）-1 and 24 h urinary albumin excretion rate （24 h UAER） were observed before and after treatment. Result： The levels of 24 h UAER and SCr in the two groups were significantly decreased after treatment （P〈0.05, P〈0.01）. The levels of 24 h UAER and SCr in the observation group were （72.3±15.8） mg · （24 h）^-1, and （65.8±20.6） μmol · L^-1, significantly lower than （87.6±17.2） mg · （24 h）^-1, （91.6±23.8） μmol · L^-1 in the control group, with statistically significant difference （P〈0.05）. The levels of MDA, vWF, and ET-1 in the observation group were （4.01±0.4） μmol · L^-1, （159.5±26.4）%, and （55.7±7.2） ng · L^-1 after treatment, significantly lower than those before treatment （P〈0.05） and significantly lower than （5.31±0.51） μmol · L^-1, （181.3±28.2）%, and （60.4±7.5） ng ·L^-1 in the control group after treatment, with statistically significant difference （P〈0.05）. The level of SOD in the observation group was （129.3±7.1） U · mL^-1after treatment, significantly higher than the level before treatment （P〈0.05） and significantly higher than （70.2±4.5） U · mL^-1in the control group after treatment, with statistically significant difference （P〈0.05）. Conclusion： Yishen Huashi granules have strong antioxidant effect, which can effectively delay the vascular endothelial injury and reduce urinary protein excretion. Yishen Huashi granules combined with sulodexide have more obvious effect on regulating vascular endothelial function and delaying the development of early diabetic nephropathy.